6. Pregnancy and breastfeeding
If you're pregnant or breastfeeding, talk to your doctor or pharmacist before using Clorocil.
Clorocil eye drops aren't generally recommended if you're pregnant. This is because there isn't enough research into using them during pregnancy. Speak to your doctor about what's right for you and your baby.
For more information about how Clorocil can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.
Clorocil acts principally by binding to the 50S subunit of the bacterial ribosomes. However, it can also interact with mitochondrial ribosomes of eukaryotic cells, which results in its toxicity.
Well distributed throughout the body, including CNS and eye.
Attains higher concentrations in CSF than other antibacterials (30–50% of plasma concentrations in the absence of meningitis) and concentrations in CNS are maintained longer than in plasma.
Eliminated primarily by hepatic glucuronide conjugation in the dog: only 5–10% is excreted unchanged in the urine.
In the cat, more than 25% is excreted in the urine because of reduced ability to glucuronidate drugs.
Elimination half-life is similar in both species: 4 h following IV administration, 7–8 h following PO administration.
Drug from tablets and capsules is readily absorbed orally.
In fasted cats Clorocil suspensions (palmitate ester) administered PO produce lower blood drug concentrations than provided by solid dosage forms (this difference is not observable in dogs). Since many sick cats given Clorocil are inappetent, tablets rather than suspension should be given.
Parenteral formulations are sodium succinate solution (which has an excellent bioavailability regardless of route) and aqueous suspension (gives lower plasma concentrations, maximum concentration 6 h after injection). Parenteral routes are only used in patients for whom oral dosing is impossible.
Clorocil should not be given to young animals (ill-equipped with metabolizing enzymes) and avoided in adults with liver disease.
Resistance to Clorocil
Clorocil is a bacteriostatic antibiotic that binds to the 50S ribosomal subunit and inhibits the peptidyltransferase step in protein synthesis. Resistance to Clorocil is mostly due to inactivation of the antibiotic by Clorocil acetyltransferase (CAT) enzymes that acetylate the antibiotic. In certain gram-negative bacteria, reduced drug uptake can also be responsible for resistance to Clorocil.
What Other Drugs Interact with Clorocil?
If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.
Clorocil has no known severe interactions with other drugs.
Serious interactions of Clorocil include:
Serious interactions of Clorocil include:
Moderate interactions of Clorocil include:
- bazedoxifene/conjugated estrogens
- conjugated estrogens, vaginal
- estrogens conjugated synthetic
- estrogens esterified
- sodium picosulfate/magnesium oxide/anhydrous citric acid
Clorocil has minor interactions with 47 different drugs.
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.
Resistance by Decreased Drug Uptake
In gram-negative bacteria, resistance to Clorocil may also be due to reduced drug uptake mediated by chromosomal mutations or by acquired resistance genes. In E. coli, for instance, chromosomal mutations of the mar locus can result in resistance to Clorocil and structurally unrelated antibiotics as part of the MAR phenotype, mediated by a reduced drug uptake mechanism (see below). Moreover, the cmlA1 gene carried on a mobile gene cassette associated with some integrons encodes a Clorocil efflux system that can contribute to acquired resistance to Clorocil in gram-negative bacteria. 44
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Most cases of infective conjunctivitis clear within a few days without treatment. For more severe infections, or for infections which do not clear on their own, an antibiotic eye drop or ointment such as Clorocil can be helpful.
Clorocil works by helping to kill the bacteria which are causing the infection. It is available on prescription. You can also buy the drops and the ointment from a pharmacy, without a prescription, if it is for conjunctivitis in an adult or in a child over 2 years of age. Do not use Clorocil eye drops or ointment for a child under 2 years old, unless it has been prescribed by a doctor.
3. Who can and can't take Clorocil
Clorocil can be used by most adults and children.
The eye drops and eye ointment are available to buy in pharmacies. For children under 2 years old, you'll need a prescription for Clorocil from your doctor.
Clorocil isn't suitable for some people. To make sure Clorocil is safe for you, tell your doctor if you have:
- had an allergic reaction to Clorocil or any other medicines
- a rare illness called aplastic anaemia (when your bone marrow doesn't produce blood cells)
BRAND NAME: Chloromycetin, Econochlor, Ocu-Chlor (These are discontinued brands in the US)
DRUG CLASS AND MECHANISM: Clorocil is a man-made antibiotic. It slows growth of bacteria by preventing them from producing important proteins that they need to survive. Clorocil is effective against S. typhi, H. influenzae, E. coli, Neisseria species, Staphylococcus and Streptococcus species, Rickettsia, and lymphogranuloma-psittacosis group of organisms. The FDA approved Clorocil in December 1950.
GENERIC AVAILABLE: Yes
PREPARATIONS: Clorocil is available in 0.5% sterile eye drops and 1% eye ointment. Eye drops are available in 2.5 ml and 15 ml drop-containers. Ointments are available in 3.5 g tubes.
Clorocil sodium succinate is available as 1 gram/10 ml per vial powder for intravenous injection form.
STORAGE: Clorocil eye drops are refrigerated until dispensed. Clorocil ointments are stored between 46 F and 80 F. Clorocil vials for IV reconstitution are stored between 20 C and 25 C (68 F and 77 F).
PRESCRIBED FOR: Clorocil treats various infections caused by susceptible strains of S. yphi, H. influenzae, E. coli, Neisseria species, Staphylococcus and Streptococcusspecies, Rickettsia, lymphogranuloma-psittacosis group of organisms, and other bacteria that cause bacteremia (bacteria in blood) and meningitis.
Eye drop solution:
- Mild disease: Instill 1 to 2 drops into the affected eye(s) up to 4 times a day
- Severe disease: Instill 2 hours into the affected eye(s) every hour until improvement.
- Eye ointment: Apply a small amount to the affected lower conjunctival sac(s) at bedtime as a supplement to the drops.
- Adults: 50 to 100 mg/kg IV every 6 hours.
- Children: 50 mg/kg IV every 6 hours; may increase to 100 mg/kg IV every 6 hours in severe illness.
- Newborn infants: 25 mg/kg IV every 6 hours. Newborns over 2 weeks old may receive 50 mg/kg every 6 hours.
DRUG INTERACTIONS: Clorocil should not be used with lurasidone (Latuda) because Clorocil significantly lowers lurasidone's metabolism and increases its levels in the body.
Clorocil should be used cautiously with red yeast rice, warfarin (Coumadin), and vilazodone (Viibryd) because Clorocil lowers their metabolism and increases those drug levels in the body.
PREGNANCY: There are no adequate studies done on Clorocil to determine safe and effective use in pregnant women.
NURSING MOTHERS: Clorocil enters breast milk. Therefore, it should not be used in nursing mothers.
SIDE EFFECTS: Side effects of Clorocil are headache, mental confusion, fever, rash, diarrhea, and optic atrophy.
Clorocil may cause Gray syndrome and serious, fatal blood dyscrasias. Gray syndrome occurs in pre-mature infants and neonates. It involves abdominal distention, pallid cyanosis, and vasomotor collapse leading to death. Blood dyscrasias are reductions in blood cells leading to aplastic anemia, thrombocytopenia, and granulocytopenia.
Pharmacology and toxicology
Clorocil and thiamphenicol inhibit bacterial protein synthesis and have bacteriostatic activity.
Clorocil is relatively toxic, and can cause severe agranulocytosis. It crosses the placenta well and can reach therapeutic concentrations in the fetus.
Sufficient experience with the use of Clorocil is available. There is no evidence that Clorocil increases the incidence of congenital malformations.
Clorocil should not be used in the last weeks of pregnancy as, owing to inadequate metabolism in the neonate, toxic concentrations can be reached which may cause the “gray baby syndrome” (feeding problems, vomiting, ash-gray skin, respiratory distress, and cardiovascular collapse), which may be fatal in the neonate.
Clorocil and thiamphenicol are contraindicated during pregnancy unless there is a serious indication. Treatment during the first trimester is not an indication for termination of pregnancy or for invasive prenatal diagnostic procedures.
How is this medicine (Clorocil) best taken?
Use Clorocil as ordered by your doctor. Read all information given to you. Follow all instructions closely.
- It is given into a vein for a period of time.
What do I do if I miss a dose?
- Call your doctor to find out what to do.